Remote Session Registration

 


 If you wish to receive a session, please fill out the details below.  


Name _________________________________   Today's Date _____________

New Moon  ____       Full Moon ____     New Year's Eve ____    New Years Day ____   Holiday Package ____

       Check  ____  Money Order ____  Pay Pal ____ (for Pay Pal payment, add 5% to total)

Signature    _____________________________________

Quantity .   .  .   .   .   .   .   . _____________  @  Suggested Price: $175.00 ea.    _________
                                                                       with feedback*:     $500.00 ea.    _________
                                                                       holiday package: $649.00  ea.   _________

                                                                                                               Total            $ __________

* Subject to availability


Credit card payments are accepted, and payment through PayPal is available.  Please go to www.paypal.com.  When you arrive at the “Send Money” option, enter in this email address:    This email address is being protected from spambots. You need JavaScript enabled to view it. .  You will be required by PayPal to set up an account with them.  Be sure also to e-mail your request to  This email address is being protected from spambots. You need JavaScript enabled to view it. .

If you are using Pay Pal,  make sure that the Recipient is The Center For Contemplative Awareness.

Checks should be made payable to The Center for Contemplative Awareness.

 

Checks may be mailed to:         The Center for Contemplative Awareness
                                                  7529 Sunset Blvd.
                                                  Los Angeles CA 90046  USA For any questions or inquiries please contact Kirpal, Vice President of the Center for Contemplative Awareness.

 E-mail:  This email address is being protected from spambots. You need JavaScript enabled to view it.      fax: 323-436-0831 phone: 323-436-0264

 

 

Your Complete Address  _______________________________________
                             
      ____________________________________________
                                          ____________________________________________

Telephone Numbers:        Day  (____) ______________________________
                                      Evening
(____) _______________________________
                                        
Mobile (____) _______________________________
                                             Fax
(____) _______________________________
E-Mail Address
                          ___________________________________ @ _____________________



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